Individual
INDERVIR MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3300 KEMP RD, BEAVERCREEK, OH 45431-4200
(585) 623-7599
Mailing address
3300 KEMP RD, BEAVERCREEK, OH 45431-4200
(585) 623-7599
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30.026218
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0412777
—
OH
Enumeration date
07/19/2017
Last updated
08/24/2020
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